Background: The attitudes, beliefs, and experience of physicians will influence how they view
the use of opioids for chronic nonterminal pain.
Objective: To survey pain specialists and primary care providers (PCPs) to obtain their opinion
and attitude on aberrant drug-taking behaviors.
Design: We surveyed three physician groups, mailing 250 surveys followed by two followups.
The survey consisted of (1) questions about beliefs in the effectiveness of long-term opioid
therapy and successful and unsuccessful outcomes and (2) a ratings section for possible
indicators of unsuccessful long-term opioid treatment.
Results: In total 147 questionnaires (82 PCPs, 65 pain specialists) were returned. Pain specialists
reported a greater number of patients undergoing long-term opioid therapy compared
to nonpain specialists. Opinion regarding the effectiveness of long-term opioid therapy among
all physicians was mixed but there was no significant difference between pain specialists and
PCPs. There was agreement among physicians with regard to highly aberrant behaviors being
indicators of failed long-term opioid therapy. The ratings of the following indicators
showed differences between each group: no improvement in pain control, not being able to
return to work, and a deterioration in relationships with others. Physicians reported increases
or decreases in function to be the most important successful or unsuccessful outcome, respectively.
Conclusions: This preliminary survey showed consensus among physicians that highly aberrant
behaviors indicate a failure of chronic opioid therapy. However, when considering less
egregious behaviors, it would appear a physician's experience and the number of patients
they had taking opioids influenced their opinion.
